A local 16-year-old boy, called brilliant and nicknamed “The Piano Man” for his musical talent, yet burdened with severe depression, ended his life several weeks ago, leaving devastated family members, teachers and friends, and many unanswered questions. As notes of friendship flooded his Facebook page, many were left wondering why and what they could have done.

Depression affects approximately 2 percent of children nationwide and 6 percent of teenagers at any given time, according to Dr. Shashank V. Joshi, assistant professor of psychiatry and behavioral sciences at the Stanford School of Medicine.

“Twenty to 25 percent will have experienced depression of some sort by the time they graduate from high school,” Joshi said, describing this depression as feeling in a sad mood for more than a few days. Most bounce back and continue with normal activities and friendships.

But for some, the depression lingers. And many teens will suffer in silence, as, according to Joshi, they often don’t talk about their own depression, what he calls a “brain-based medical condition.”

The cause of this painful disorder? According to the Stanford University Depression Research Clinic website, the exact cause of depression is still unknown, but biological, psychological and environmental factors can be contributors. It is thought that an imbalance of certain neurotransmitters in the brain, such as serotonin, norepinephrine and dopamine, can contribute to some people’s depression. Antidepressants target biological causes associated with an imbalance of neurotransmitters in the brain.

“The neurotransmitter story is not the whole story. … There are areas of the brain that can change with talk therapy,” Joshi said. Treatments for mild to moderate depression include cognitive behavioral, or talk, therapy, he said, while moderate to severe depression is treated with a combination of psychotherapy and medication.

One 46-year-old Mountain View woman, a mother of two teen boys, is a testament to the value of therapy. At age 12, she was drinking on a regular basis, often with her loving but permissive parents. Teen angst about new schools and “fitting in” followed.

Then her friends turned on her. “I felt like I didn’t have anybody” when social life was all that mattered, she said. “I felt like I would never be able to get out of a hole of despair.” Following several suicide attempts, a friend took her to rehab; there, she underwent therapy and learned healthy ways of coping. “I had to deal with feelings,” she said, adding that she was “raw with all of these feelings.”

And teens can be good at covering up their feelings. What are some warning signs that a teen might be at risk? Joshi says that signs include talk of self-harm, changes in behavior, loss of interest, giving possessions away, isolating, and talking about death and dying.

In a talk at New York University several years ago that was posted on YouTube, Joshi noted that 65 percent to 90 percent of those who take their lives have been diagnosed with a mental health disorder for at least a year. Additional stressors can include disconnection to others, poor coping styles, issues with bullying, substance abuse, sexual orientation confusion, mood disorders in the family, and suicides or attempts in the family.

“The problem is that many families and peers are unaware of the signs and symptoms of worsening teen depression,” Joshi wrote in an email, “and may not be sure when and how to seek help.”

What do you do? Pay attention, Joshi recommends. If a teen is in a sad mood for a week or more, shows a loss of interest or withdrawal from friends, and is no longer doing what she likes to do, ask questions. Talk to the teen’s primary care provider or school counselor. Read about depression. Go to the Heard Alliance website (where there are questionnaires, under resources, and educational information on depression, mood disorders, anxiety, and more), and the American Academy of Child and Adolescent Psychiatry website.

Joshi backs up his words with actions; he’s involved in training kids to help each other, is promoting an educational “More Than Sad” program at schools, and is helping to provide education in health and life skills classes about depression and stress, and ways to cope.

Here, clearly, is a man on a mission. He sits on the Suicide Prevention Oversight Committee for Santa Clara County, is involved with schools as director of school mental health services at the Lucile Packard Children’s Hospital, and is director of training in child and adolescent psychiatry for the Department of Psychiatry.

There is hope. In the halls of the Lucile Packard Children’s Hospital, in the offices at the Stanford Depression Research Clinic, and even in the church where the teen boy’s life was recently celebrated.

In a powerful send-off, a father recently told an overflow crowd of more than 1,000, “We are going to finish the job [of God’s plan for my son’s life]. We are going to love one another in a way that makes the world say, ‘What kind of love is this?'”

With lower home prices, more Californians could afford a home purchase in the fourth quarter of 2018 compared to the previous quarter, but the California Association of Realtors reports higher interest rates lowered affordability from the previous year for most counties.